Anemia in Pregnancy Flashcards
what deficiency has a Total Iron requirement for a pregnancy is1000 mg. Diet rarely meets pregnancy needs
Iron Deficiency
2nd and 3rd trimesters:
Hgb - < 11 mg/DL
Hct - < 33
What is sickle cell disease?
autosomal recessive disorder. The defect causes erythrocytes to assume an S shape. They tend to clump together and occlude small bv’s. The disease is characterized by chronic anemia, susceptibility to infection, and recurring episodes of sickle cell crisis.
Essential for formation of rbc’s, cell duplication and placental and fetal growth. Maternal needs 2X during pregnancy r/t need for more erythrocytes, plus placental and fetal growth.. Caused by nutritional deficiencies (folate), hemolytic anemias, mal-absorption, and specific medications. What is the deficiency called?
Folic Acid Deficiency
What are the maternal symptoms of sickle cell
Pregnancy may precipitate sickle crisis. Sickle crisis associated with:
(1) jaundice r/t decreased bone marrow function and massive erythrocyte destruction
(2) pain r/t major infarcts in joints and all major organs.
what deficiency has Neural tube defects
Folic acid deficiency
what is the therapeutic management of of iron deficiency in pregnant women
Elemental iron 200 mg; at least 3 months after correction of anemia.
Adult Female: 15 mg
Pregnancy: 30 mg
Parenteral: Z track method of injection
Absorption decreased with milk, tea, and coffee
Absorption increased in presence of Vit C; melon, strawberries (any food high in C).
What are the fetal effects of sickle cell?
Prematurity
IUGR -not growing at the rate its supposed to
Fetal death during a sickle crisis
how much folate supplements should a female/pregnant women should take?
Folate supplement
Adult Female: 180ug
Pregnancy: 400 ug
Lactation: 280 ug
Dietary
What deficiency receives adequate iron at cost to mother. In presence of severe maternal anemia, reduced hemoglobin and O2 compromised baby.
Iron
Presence of megaloblasts (large, immature erythrocytes)
Increased risk of spontaneous abortion, abruptio placentae, and fetal anomalies
Are what type of deficiency?
Folic acid
What should be the therapeutic management of sickle cell disease?
Adequate hydration
Adequate nutrition
Folate supplement
Rest periods
Prompt tx of illness/infection.
What are the s/s of iron deficiency
Pallor
Fatigue
Lethargy
HA
Pica for various substances
Microcytic, hypochromic rbc’s
How is toxoplasmosis transmitted?
- Raw meat,
- Infected animal (cat) feces
- Transplacental
What are the maternal effects of Varicella Zoster
Preterm labor, encephalitis, and varicella pneumonia.
Deafness, MR, IUGR, cardiac defects and microcephaly are all fetal/neonatal effects of?
Rubella
How should a patient manage Cytomegalovirus
No effective tx. Therapeutic ab considered if a primary infection occurs in 1st 20 weeks of pregnancy.
- Influenza-like aching
- Lymphadenopathy
- Spontaneous abortion
are maternal effects of Toxoplasmosis
What are fetal/neonatal effects of Varicella Zoster
Congenital varicella syndrome c limb hypoplasia, cataracts, microcephaly, and symetric IUGR during 1st trimester.
Management for Varicella Zoster
Varicella immune globulin for susceptible clients exposed during pregnancy. Neonate born to mother with an active varicella infection is given immune globulin within 72 hours. Strict isolation for both mother and neonate.
Management for rubella
Prevent by rubella vaccinations in childhood. Rubella titer of 1:8 is evidence of immunity. If vaccinated in adulthood, document understanding of pregnancy prevention for 3 months p vaccination.
- Transplacental*
- Body fluids
Cytomegalovirus transmission
Congenital toxoplasmosis, LBW; hepatosplenomegaly c Jaundice and anemia are all fetal/neonatal effects of ?
Toxoplasmosis
What are the forms of transmission of Rubella
- Transplacental
- Direct contact
- Respiratory droplets
Forms of transmission for Varicella Zoster
- Direct contact
- Respiratory droplets.
Rash, fever , malaise. Spontaneous ab during 1st trimester of pregnancy are all maternal effects of
Rubella
What are the maternal effects of Cytomegalovirus
Flu-like symptoms; cervical discharge
Avoid eating uncooked meat; avoid exposure to litter used by infected cats. Titer checked during pregnancy. Elective ab may be discussed if titer is high during early pregnancy.
this is the management of ?
Toxoplasmosis
Cytomegalovirus fetal/neonatal effects
Fetal or neonatal death; Severe generalized disease c hemolytic anemia, jaundice, hydrocephaly or microcephaly.
Mode of transmission of AIDS
- Sexual exposure
- Parenteral
- Perinatal exposure of an infant to an infected mother.
Sepsis, pneumonia or meningitis within 7 days of birth. Meningitis most common clinical symptom. Early (1st week of life, or late onset). May have permanent neurologic deficits. Effects of fetal/neonatal is associated with what infection
Group B Streptococcus
Maternal effects of Hep B
Fever, rash, arthralgia, abdominal pain, liver enlarged and tender.
Management of AIDS
Prevention
Safe sex practices, Barrier contraceptives
Zidovudine (ZDV).
- Transplacental
- Body fluids: blood, saliva, vaginal secretions, semen and breast milk;
- Contaminated needles or blood transfusion.
transmission of what infection
Hepatitis B
IV antibiotics to mother in labor and/or to infant after birth is the management of what?
Group B Streptococcus
What are the two parts of maternal effects for STD’s
Antepartum – An increased incidence of other STD’s. Offered the option of ZDV.
Intrapartum – External EFM preferred. Avoid use of fetal scalp electrodes or blood sampling.
Postpartum – breastfeeding contraindicated. Universal precautions for Mom and baby.
Fetal/neonatal effects of Hep B
Prematurity; LBW. Development of acute infection at birth and perhaps neonatal death.
Two ways Group B Streptococcus can be spread
- Colonizes in the rectum, vagina, cervix and urethra of women.
- Ascends after ROM or during birth.
Management of Hep B
All pregnant women are screened for HbsAG. At risk clients rescreened in 3rd trimester. Newborn given immune globulin at birth to prevent infection from skin surface contamination. Repeated at 1 and 6 months of age. (Institution policy).
If mother is HIV+ the newborn is given ELISA test for presence of HIV antibodies. If positive but asymptomatic at birth, s/s usually become evident during 1st year of life. FTT, liver and spleen involvement, bacterial infections are most common.
these are all
fetal/neonatal effects
What is Group B Streptococcus (GBS)
Gram + bacteria
What are AIDS
caused by retrovirus HIV. Depletes the body’s immune system so that overwhelmed with opportunistic infections.
Hep B is?
a vaccine-preventable liver infection caused by the hepatitis B virus
What is Cytomegalovirus
A herpes virus. Becomes latent after primary infection. Periodic reactivation and shedding.
What another name for Rubella
German measles
Varicella Zoster is
(chicken pox)
Usually included as “other” but could be many others.
Another name for Toxoplasmosis is
Protozoan
